| 王玉蓉,江雨璐,吴文清.细胞蜡块在恶性胸腔积液诊断和个体化治疗中的价值[J].安徽医药,2025,29(10):2074-2078. |
| 细胞蜡块在恶性胸腔积液诊断和个体化治疗中的价值 |
| Value of cell blocks in the diagnosis and personalized treatment of malignant pleural effusion |
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| DOI：10.3969/j.issn.1009-6469.2025.10.033 |
| 中文关键词: 胸腔积液，恶性 细胞蜡块 肺腺癌 免疫组织化学 基因检测 |
| 英文关键词: Pleural effusion,malignant Cell block Lung adenocarcinoma Immunohistochemistry Genetic testing |
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| 中文摘要: |
| :目的探讨细胞蜡块在恶性胸腔积液( malignant pleural effusion，MPE)中的病理诊断优势，并阐述其联合免疫组化和基因检测在精准化治疗中的价值。方法回顾性分析中国科学技术大学附属第一医院 2019年 11月至 2023年 6月确诊的 130例 MPE的细胞病理学涂片及细胞蜡块的 HE形态，分析细胞蜡块的免疫组化表达。对部分确诊肺腺癌的细胞蜡块，进行表皮生长因子受体( EGFR)/间变性淋巴瘤激酶( ALK)/ROS原癌基因 1(ROS1)/Kirsten大鼠肉瘤病毒癌基因同源物(KRAS)/B-Raf原癌基因丝苏氨酸蛋白激酶( BRAF)基因突变检测。结果肿瘤细胞在细胞蜡块中更丰富，在排列方式和结构上还可观察到类似的组织学形态。 130例 MPE中，细胞蜡块经免疫组化染色后诊断，肺腺癌 82例，乳腺癌 9例，肺小细胞癌 4例，卵巢癌 7例，淋巴造血组织肿瘤 8例，胃癌 4例，肺鳞状细胞癌 2例，喉未分化癌 1例，恶性黑色素瘤 1例，食管鳞状细胞癌 1例，恶性但无法明确来源 11例。在对确诊的肺腺癌进行 EGFR、ALK、ROS1、KARS、BRAF基因突变检测中， EGFR突变率 67.74%(21/31例)，ROS1融合突变率为 7.14%(2/28例)，ALK突变率为 11.11%(3/27例)，BRAF的突变率 0%，KRAS的突变率 0%。结论恶性胸腔积液的细胞蜡块进行免疫组化检查，有助于明确诊断及肿瘤来源的判断，其分子分型，为后续精准化治疗肺腺癌病人提供可靠依据。 |
| 英文摘要: |
| Objective To explore the pathological diagnostic advantages of cell blocks in malignant pleural effusion (MPE), and toelucidate the value of their combined immunohistochemistry and gene testing in precision treatment.Methods HE morphology of cellpathology smears and cell blocks of 130 confirmed cases of The First Affiliated Hospital of University of Science and Technology of Chi-na from November 2019 to June 2023 were retrospectively analyzed, and immunohistochemical expression of cell blocks was analyzed.EGFR/ALK/ROS1/KARS/BRAF gene mutation detection was conducted for cell blocks partially diagnosed with lung adenocarcinoma.Results The tumor cells in the cell block were more abundant, and a histological like arrangement and structure could also be ob-served. Among 130 cases of MPE, the cell blocks were diagnosed by immunohistochemical staining. There were 82 cases of lung adeno-carcinoma, 4 cases of small cell lung cancer, 9 cases of breast cancer cancer, 7 cases of ovarian cancer, 8 cases of lymphohematopoieticsystem tumors, 4 cases of gastric cancer, 2 cases of squamous cell lung cancer, 1 case of undifferentiated laryngeal cancer, 1 case of ma-lignant melanoma, 1 case of esophageal squamous cell carcinoma, 1 case of pancreatic cancer, and 11 cases of unknown origin adeno-carcinoma. EGFR/ALK/ROS1/KARS/BRAF gene mutation detection was conducted for diagnosed lung adenocarcinoma, EGFR muta-tion rate was 67.74% (21/31 cases), ALK mutation rate was 11.11% (3/27 cases), ROS1 fusion mutation rate was 7.14% (2/28 cases),KRAS mutation rate was 0% (0/17 cases), and BRAF mutation rate was 0% (0/17 cases).Conclusion The combination of cell blocks and immunohistochemistry in MPE helps to clarify the diagnosis and determine the source of tumors, and its precise molecular typingprovides a reliable basis for subsequent precise treatment of lung adenocarcinoma patients. |
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